New Research Presented at the 5th Annual Breast Cancer Symposium

Co-sponsored by the American Society of Breast Disease, the American Society of
Breast Surgeons, the American Society of Clinical Oncology, the American Society
for Radiation Oncology, the National Consortium of Breast Centers, and the Society
of Surgical Oncology

New studies on breast cancer screening, treatment, and survival were presented at the 2011 Breast Cancer Symposium held September 8-10, 2011, in San Francisco, California.

Two Studies Report Similar Recurrence,
Survival Rates for Breast
Conservation and Mastectomy Among
Younger Women with Breast Cancer
A pair of studies indicates comparable
outcomes – in local recurrence and
survival rates – for lumpectomy or mastectomy
among women with breast cancer
age 40 and younger. Young age at diagnosis
is considered a risk factor for breast
cancer recurrence, and there has been
a trend in recent years among young
women to increasingly choose mastectomy
rather than lumpectomy – despite
a lack of definitive evidence showing
improved survival. As a result, these
findings may have important implications
in treatment decisions.

Study Finds Recurrence Rates
Are Similar in Younger Women Who
Have Either Breast Conservation
Surgery or Mastectomy
In this retrospective study, Julliette
Buckley, MD, a fellow in breast surgery
at Massachusetts General Hospital, and
colleagues reviewed medical records of
628 women age 40 and younger who
were diagnosed with up to stage III breast
cancer. They examined various patient
demographic data and determined rates
of local recurrence, distant recurrence,
and overall survival. When they analyzed
the data according to the type of
surgery the women had, they found no
statistically significant difference in
local cancer recurrence risk.

“Although the majority of women in
our study underwent breast-conserving
therapy, previous research has suggested
that this procedure leaves women at
greater risk for local recurrence. However,
we found no significant difference
in the rates of local recurrence between
women treated with breast-conserving
surgery or mastectomy. These results
suggest that advances in chemotherapy,
imaging, and radiation have reduced
local and distant recurrence risks and
have made breast-conserving therapy
a safe option for many young women,”
said Dr. Buckley.

Analysis Shows Breast Conservation
and Mastectomy Result in Similar
Survival Among Younger Women
with Early-Stage Breast Cancer
Investigators led by Usama Mahmood,
MD, a fellow in radiation oncology
at The University of Texas MD Anderson
Cancer Center, compared overall
survival and breast cancer-specific survival
among women ages 20 to 39 who
were diagnosed with early-stage breast
cancer. Of these women, 45 percent
received breast conservation therapy
and 55 percent underwent mastectomy.
After accounting for a number of variables,
they found no difference in overall
and cancer-specific survival between
the two groups.

“Our findings provide reassurance
that breast conservation therapy leads to
similar survival outcomes as mastectomy
even in younger women with early-stage
breast cancer,” said Dr. Mahmood.
“These findings can provide reassurance
to younger women with early-stage
breast cancer who are considering less
aggressive surgery.”

New Statistical Tool May Predict
Risk of Lymphedema Associated
with Breast Cancer Surgery
Researchers have created a set of
statistical models that are more than 70
percent accurate for predicting the fiveyear
risk of developing lymphedema
after lymph node removal during breast
cancer surgery. While the models continue
to be refined, they could eventually
become a useful decision-making tool
for physicians. These findings have important
implications because it is currently
very difficult to predict which women
will develop this surgical side effect.

In women with breast cancer,
lymphedema is a swelling under the arm
characterized by localized fluid retention
and tissue swelling that can occur
following axillary lymph node surgery,
which is often necessary if the cancer
has spread to the lymph nodes. It can
be a chronic, disabling condition, and
it affects about one-third of those who
have axillary lymph node surgery.

Investigators led by Jose Bevilacqua,
MD, phd, a surgical oncologist at
Hospital Sirio Libanes in Sao Paulo,
Brazil, prospectively studied about 1,000
women with breast cancer undergoing
axillary dissection. The overall five-year
incidence of lymphedema in the group
was 30.3 percent.

Using a variety of clinical factors, the
researchers developed three models to
predict the risk of developing lymphedema
at different points in time following
surgery. The researchers compared the
models’ predictions to the actual occurrence
of lymphedema in this group
of women and found that the models
correctly predicted a person would develop
lymphedema more than 7 out
of 10 times.

“These models performed well,” Dr.
Bevilacqua said. “The statistical models
[…] use readily available clinical
factors and allow for quick and easy
estimation of individual risks of developing
lymphedema after axillary lymph
node surgery in women with breast cancer.
For the sake of comparison, these
modeling tools are as accurate for predicting
a woman’s risk of developing
lymphedema as mammography is for
the detection of breast cancer.”
Dr. Bevilacqua suggested that the
models may become useful tools to help
physicians choose whether to recommend
axillary dissection.

Additional Studies of Note

Impact of Chemotherapy Timing
on Local-Regional Failures in Women
Undergoing Breast-Conserving Therapy
“Traditionally, surgery has been performed
prior to chemotherapy in women with large
breast cancers. This study demonstrated
that in women undergoing chemotherapy
first, the risk of local recurrence was the same
as in women undergoing surgery first. Administering
chemotherapy first may allow
for ‘downstaging’ or a significant decrease
in the size of the cancer prior to surgery.
There is no adverse effect on recurrence
rates. While this study did not address cosmesis,
decreasing the size of the tumor prior
to surgery may allow for a more cosmetically
acceptable lumpectomy to be performed.”
– Deanna Attai, MD, Center for Breast
Care, Inc.

Relationship Between Taxane-Induced
Neuropathy and Clinical Outcomes after
Adjuvant Chemotherapy
“As components of adjuvant chemotherapy,
taxanes improve relapse-free and
overall survival. Their use can be limited
by peripheral neuropathy. Prior work has
demonstrated the potential for single nucleotide
polymorphisms (SNPs) to predict for
taxane neurotoxicity. The current analysis
[…] provides reassurance that taxane neuropathy
is not linked to taxane benefit.”
– Andrew D. Seidman, MD, attending
physician for the Breast Cancer Medicine
Service at Memorial Sloan-Kettering
Cancer Center

Male Breast Cancer: Survival Rate
and Determinants of Prognosis
“While the study itself has some limitations,
the authors confirm what has been
shown historically. Breast cancer in men
occurs later in life, is frequently associated
with a delay in diagnosis, and is commonly
associated with lymph node involvement.
Although breast cancer is rare in men, these
findings demonstrate that it is critically important
to continue to raise awareness
about the occurrence of breast cancer in
men.” – Gail S. Lebovic, MA, MD, FACS,
past president of the American Society
of Breast Disease

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This article was published in Coping® with Cancer magazine,
September/October
2011.